New reconstruction tools in acute stroke: time-, contrast material-, and dose-saving together with better diagnostic value

本研究旨在开发一种重建算法，该算法能够从单次双能量CTA中计算有关急性卒中的必要和额外信息。这可能导致节省时间、辐射剂量和造影剂，并且可能对中风患者的急性治疗产生很大影响。我们计划三个步骤（里程碑）来达到这个目标：首先，我们不需要建立一个保存诊断协议，因为我们已经有了它。但我们需要在研究的第一阶段提前获取数据。我们将前瞻性收集将在3个月的临床常规期间采集的数据，包括标准双能量CTA。根据德国卒中患者指南，将对脑进行额外的自体CT扫描。扫描和周围的程序是等同于我们的标准治疗。该研究对患者的治疗或治疗决策没有任何影响。其次，我们将从定期采集的CT数据中重建虚拟图像：我们使用这些数据重建虚拟原始CT扫描，从而能够排除颅内出血。此外，我们将尝试开发一种算法，该算法能够可视化脑实质缺血和非缺血区域中造影剂材料的分布。这些数据集可能能够在急性期可视化急性中风，这将是急性中风成像的巨大进步。这将另外节省造影剂和辐射剂量，并且-在这种紧急情况下-还缩短诊断和治疗之间的时间。建立新的诊断程序：最后一个目标是建立用于急性中风患者的新的诊断程序。绝对有必要确保本研究不会对诊断和治疗的指南一致性产生影响。为了评估诊断准确性，我们需要至少100个数据集，这些数据集将在2年内获得。这种前瞻性数据采集将不会随机化，因为没有伦理上可接受的诊断或治疗替代方案。

This study aimes to develop an reconstruction algorithm that is able to calculate the necessary and additional information about an acute stroke from a single dual energy CTA. This may lead to a time-, radiation dose- and contrast material saving and could have a high impact on the acute treatment of stroke patients. We plan three steps (milestones) to reach this aim:First we do not need to establish a save diagnostic protocoll because we have it already. But we need to acquire the data propectively in this first phase of the study. We will prospectively collect the data that will be acquired during clinical routine for 3 months including a standard Dual-Energy CTA. According to the german guidelines for stroke patients an additional native CT scan of the brain will be done. The scan and the procedures around are equal to our standard treatment. The study does not have any impact on pateint´s treatment or therapeutic decisions.Second we will reconstruct virtual images out of the regularly acquired CT data: We use the data to reconstruct virtual native CT scans that will be able to exclude an intracranial bleeding. Additionally we will try to develop an algorithm that is able to visualize the distribution of the contrat material in the ischemic and non-ischemic areas of the brain parenchyma. These datasets might be able to visualize the acute stroke during the acute phase and would be an enormous step forward in acute stroke imaging. this would additionally save contrast material and radiation dose and -in this emergency setting- also shorten the time from between diagnostics and therapy.Establishing a new diagnostic procedure:The last aim is to establish a new diagnostic procedure for acute stroke patients. It is absolutely necessary that this study will never have an impact on the guideline accordance of diagnostic and treatment. For evaluating the diagnostic accurancy we need at least 100 datasets that will be acquired over 2 years propectively. This prosepctive data acquisition will not be randomised because there is no ethically acceptable diagnostic or therapeutical alternative.